Anticoagulant Therapy in Pregnant Women with Mechanical Cardiac valve Prostheses / 대한흉부외과학회지

BACKGROUND: Anticoagulant therapy can be required during pregnancy with prosthetic heart valves. Warfarin and heparin provide real protection against thromboembolic phenomena, but they also carry serious risks for the fetus and the mother. In an attempt to identify the best treatment for pregnant women with cardiac valve prostheses who are receiving anticoagulant, we studied 19 pregnancies, the warfarin was discontinued and heparin was administered every 12 hours by subcutaneous injection in doses adjusted to keep the midinterval aPTT in the therapeutic range(at least 2-2.5 control) from the conception to the 12th week of gestation and oral antiocagulant was then administered until the middle of the third trimester in the therapeutic range(at least 2 INR), and heparin therapy was restared until delivery. Also in order to avoid an anticoagulant effect during delivery, it has been our practice to instruct women to either discontinue their heparin injections with the onset of labur or to stop heparin injections 12 hours prior to the elective induction of labour. RESULT: The outcome of 19 pregnancies managed with above protocol was spontaneous abortion in 3 cases, voluntary termination in 2 cases, premature delivery at 35 weeks in 1 case and delivery at full-term in 14 cases. There was no maternal morbidity and moratality and fetopathy. CONCLUSIONS: We conclude that in the second and third trimester of pregnancy, warfarin provide effective protection against thromboembolism, Oral antiocagulant therapy should be avoided in 2 weeks before delivery because of the risk of serious perinatal bleeding caused by the trauma of delivery to the anticoagulated fetus. However, the substitution of heparin at first trimester and 2 weeks before delivery reduce the incidence of complications.

A Tunnel Technique to Protect the Skeletonized Left Internal Thoracic Artery / 대한흉부외과학회지

internal thoracic artery is used in myocardial revascularization because of many advantages. However, it may not be appropriate in the usual extrapleural or intrapleural route, because it can be easily displaced and injured due to the slender and weak characteristics. We introduce here, a simple technique of repositioning the skeletonized left internal thoracic artery in a stable and straight course by creating a tunnel between the left lateral pericardium and thymic tissue.

Dual Grafting of Left Internal Thoracic Artery and Saphenous Vein to Left Anterior Descending Artery / 대한흉부외과학회지

BACKGROUND: When internal thoracic artery (ITA) and saphenous vein graft are anastomosed to the same coronary artery, the patency rate of the internal thoracic artery graft with relatively narrow diameter may be decreased owing to competition of pressure and flow rate. We evaluate the clinical outcome and the patency of the ITA graft in patients undergoing dual grafting to the same coronary artery. MATERIAL AND METHOD: In 14 patients with the ITA graft having relatively low flow, the ITA and saphenous vein graft were anastomosed to the same coronary artery. During the mean follow-up period of 33.5 months, coronary angiography was performed in 6 patients who complained of recurrent angina, needed confirmation of graft flow, or showed postoperative Q wave. RESULT: In all 6 patients, the ITA and saphenous vein grafts were patent without stenosis or obstruction. Two patients showed good flow in both grafts, 2 showed competitive flow in the ITA graft, and the remaining 2 showed poor flow in the ITA graft. CONCLUSION: Early operative closure When saphenous vein grafting was added to the same coronary artery that the internal thoracic artery was anastomosed to, the perfusion to the coronary artery was satisfied and the dual grafting did not affect the short-term and mid-term patency rate of the ITA.

False Aneurysm of Descending Thoracic Aorta Developed by Screw in Thoracic Vertebra: A Case Report / 대한흉부외과학회지

Chronic irritation to arterial wall by foreign material may give rise to delayed vascular injury. A 50 years old male patient with kyphoscoliosis had undergone fixation of orthopedic Cotrel-Dubousset(CD) rods and screws. Fourteen months after that surgery, a false aneurysm of the descending thoracic aorta associated with pulsating hematoma in the muscular chest wall developed. The false aneurysm was managed by resecting the diseased aortic segment and replacing the vascular graft.

Endoscopic transthoracic sympathectomy : An efficient and safe method for the treatment of hyperhidrosis / 대한흉부외과학회지

Hyperhidrosis of the palms, axillae, and the face has a strong negative impact on the quality of life for many people. Existing nonsurgical therapeutic options are far from ideal. A definitive cure can be obtained by upper thoracic sympathectomy. The traditional open surgical technique is a major procedure; few patients and doctors have found that risk-benefit considerations favor surgery. Endoscopic minimal invasive surgical techniques are now available. We investigated whether endoscopic ablation of upper thoracic sympathetic chain (T2-4) is an efficient and safe treatment of hyperhidrosis. We treated 40 patients with bilateral endoscopic transthoracic sympathectomy. There were no mortalities, life-threatening complication, no treatment failures occurred in 40 patients. After a short-term follow-up, 100% of the patients reported satisfactory results. Endoscopic transthoracic sympathectomy is an efficient, safe, and minimally invasive surgical method for the treatment of palmar, axillary hyperhidrosis.